POST api/SubmitClaim/SubmitClaim

{
  "ClaimType": 1,
  "ClaimReferenceNumber": "sample string 1",
  "IsSubmit": true,
  "TravelClaimDetails": {
    "JourneyStartDate": "sample string 1",
    "JourneyEndDate": "sample string 2",
    "WasJourney": 0,
    "IsClaimResultOfAccident": true,
    "PointOfOrigin": "sample string 4",
    "PointOfDestination": "sample string 5",
    "ClaimMedicalExpensesAndHospitalBenefits": true,
    "NatureOfIllnessOrInjury": "sample string 7",
    "DateOfIllnessOrInjury": "sample string 8",
    "TimeOfIllnessOrInjury": "sample string 9",
    "PlaceOfIllnessOrInjury": "sample string 10",
    "DescriptionOfHowInjuryOccurred": "sample string 11",
    "NameAndAddressOfDoctorOrHospital": "sample string 12",
    "WasInsuredPersonPregnant": true,
    "HowManyWeek": 1,
    "IsInsuredPersonSufferedFromthisBefore": true,
    "SufferedIllnessDetails": "sample string 15",
    "DetailsOfPersonalPhysicianOrDoctor": "sample string 16",
    "MedicalExpensesAddress": "sample string 17",
    "MedicalExpensesPhoneNumber": "sample string 18",
    "MedicalExpensesFax": "sample string 19",
    "MedicalExpensesEmail": "sample string 20",
    "InPatientTreatmentDate": "sample string 21",
    "WasEACContacted": true,
    "EACContactedReason": "sample string 23",
    "DoesInsuredPersonHavePrivateHealthInsurance": true,
    "InsuranceCarrierDetails": "sample string 25",
    "WasAnEHC": true,
    "WasPresentedToHospitalOrDoctor": true,
    "CancellationOrCurtailment": true,
    "JourneyBooked": "sample string 29",
    "JourneyCancelledOrCurtailed": "sample string 30",
    "JourneyCancelledExplanation": "sample string 31",
    "PersonCausedInTripCancelledAndRelationship": "sample string 32",
    "WasEACContactedIfJourneyWasCurtailed": true,
    "ReimbursementPayable": "sample string 34",
    "WereAdditionalExpensesIncurred": true,
    "AdditionalExpensesDetails": "sample string 36",
    "TravelDelayMissedDeparture": true,
    "ReasonForDelayedOrMissedDeparture": "sample string 38",
    "ScheduledDateOfDeparture": "sample string 39",
    "ScheduledTimeOfDeparture": "sample string 40",
    "ScheduledFlightOrFerryOrTransportNumber": "sample string 41",
    "NumberOfHoursDelayed": 1,
    "ActualDateOfDeparture": "sample string 42",
    "ActualTimeOfDeparture": "sample string 43",
    "ActualFlightOrFerryOrTransportNumber": "sample string 44",
    "FlightOrFerryOrTransportName": "sample string 45",
    "PointOfDeparture": "sample string 46",
    "PointOfMissedConnection": "sample string 47",
    "TransportUsedForDeparturePoint": "sample string 48",
    "RecommencedTrip": "sample string 49",
    "AmountClaimed": 1.0,
    "BaggageMoneyDocuments": true,
    "DateOfLossOrDamage": "sample string 51",
    "Time": "sample string 52",
    "DetailedDescriptionOfLossOrDamage": "sample string 53",
    "IssuerNotifiedIfLossRelatedToTravellers": "sample string 54",
    "ReportedToAuthority": "sample string 55",
    "Item1Description": "sample string 56",
    "Item1PricePaid": 1.0,
    "Item1AmountClaimed": 1.0,
    "Item1PurchasedPalceAndDate": "sample string 57",
    "Item1CostNow": 1.0,
    "Item2Description": "sample string 58",
    "Item2PricePaid": 1.0,
    "Item2AmountClaimed": 1.0,
    "Item2PurchasedPalceAndDate": "sample string 59",
    "Item2CostNow": 1.0,
    "NameofInsurer": "sample string 60",
    "ProvideOtherInsuranceDetails": "sample string 61",
    "InsuredPolicyNumber": "sample string 62",
    "CorrespondenceAddress": "sample string 63",
    "PassportLoss": true,
    "PassportLostPlace": "sample string 65",
    "DetailsOfExpensesIncurredToReplacePassport": "sample string 66",
    "PersonalAccident": true,
    "WhenInjuryOrDeathOccur": "sample string 68",
    "DetailsOfLossOrDeathOccurred": "sample string 69",
    "WasInjuryOrDeathResultOfNatural": true,
    "NaturalCausesDetails": "sample string 71",
    "RequestId": "sample string 72",
    "AuthenticationId": "sample string 73",
    "Portal": "sample string 74",
    "Individual": "sample string 75",
    "Language": "sample string 76",
    "Oid": "sample string 77",
    "Email": "sample string 78",
    "PhoneNumber": "sample string 79",
    "IsUpdateEmailAndPhone": true,
    "ClaimName": "sample string 81"
  },
  "HealthClaimDetails": {
    "IsMaternityTreatment": true,
    "DeliveryDate": "sample string 2",
    "IllnessOccurredDate": "sample string 3",
    "ProblemDetails": "sample string 4",
    "DiagnosisDetails": "sample string 5",
    "PreviousDiagnosisDetails": "sample string 6",
    "InjuryAnyWayToPatientsOccupation": true,
    "InjuryAnyWayToAutomobileAccident": true,
    "InjuryAnyTypeOfAccident": true,
    "AccidentDetails": "sample string 10",
    "AutomobileDetails": "sample string 11",
    "CoveredByOtherGroupPlan": true,
    "CoveredByMedicareOrGovtAgency": true,
    "CoveredByAutomobileInsurance": true,
    "OtherSourceDetails": "sample string 15",
    "ProviderName": "sample string 16",
    "ProviderPhoneNumber": "sample string 17",
    "ProviderAddress": "sample string 18",
    "ProviderEmail": "sample string 19",
    "ProviderPostalCode": "sample string 20",
    "ProviderCountry": "sample string 21",
    "RequestId": "sample string 22",
    "AuthenticationId": "sample string 23",
    "Portal": "sample string 24",
    "Individual": "sample string 25",
    "Language": "sample string 26",
    "Oid": "sample string 27",
    "Email": "sample string 28",
    "PhoneNumber": "sample string 29",
    "IsUpdateEmailAndPhone": true,
    "ClaimName": "sample string 31"
  },
  "PaymentDetails": {
    "MakePaymentTo": 0,
    "ReimbursmentMethod": 0,
    "MailingAddressType": 0,
    "CheckMailingAddress": "sample string 1",
    "MailingCity": "sample string 2",
    "MailingCountry": "sample string 3",
    "MailingPostalCode": "sample string 4",
    "MailingState": "sample string 5",
    "BankName": "sample string 6",
    "BankAddress": "sample string 7",
    "BeneficiaryAccountNumber": "sample string 8",
    "BeneficiaryName": "sample string 9",
    "Routing": "sample string 10",
    "SwiftCode": "sample string 11",
    "IBANNumber": "sample string 12",
    "IntermediaryBank": "sample string 13",
    "BeneficiaryAddress": "sample string 14",
    "Currency": "sample string 15",
    "City": "sample string 16",
    "Country": "sample string 17",
    "PostalCode": "sample string 18",
    "State": "sample string 19",
    "BankId": "sample string 20",
    "BankType": 0,
    "IntermediaryBankName": "sample string 21",
    "IntermediaryBeneficiaryName": "sample string 22",
    "IntermediaryIBANNumber": "sample string 23",
    "IntermediaryRoutingNumber": "sample string 24",
    "FurtherCreditBeneficiaryName": "sample string 25",
    "FurtherCreditAccountNumber": "sample string 26",
    "IsApplyNextInvoice": true
  },
  "TreatmentDetails": {
    "TreatmentItems": [
      {
        "CoverageType": 0,
        "Cost": 1.0,
        "DateOfService": "sample string 2",
        "Description": "sample string 3",
        "DateOfPurchase": "sample string 4",
        "DrugName": "sample string 5",
        "NoOfDrugsPurchased": 6,
        "NoOfDrugsInTakePerDay": 7,
        "Currency": "sample string 8"
      },
      {
        "CoverageType": 0,
        "Cost": 1.0,
        "DateOfService": "sample string 2",
        "Description": "sample string 3",
        "DateOfPurchase": "sample string 4",
        "DrugName": "sample string 5",
        "NoOfDrugsPurchased": 6,
        "NoOfDrugsInTakePerDay": 7,
        "Currency": "sample string 8"
      }
    ],
    "TotalPaidAmount": 1.0,
    "TotalUnpaidAmount": 2.0
  },
  "AdditionalNotes": {
    "AdditionalNote": "sample string 1"
  },
  "Attachments": [
    {
      "FileName": "sample string 1",
      "FilePath": "sample string 2",
      "FileType": "sample string 3",
      "FileSize": 4.0,
      "DocType": 1,
      "FormattedName": "sample string 5",
      "IsPMESupported": true
    },
    {
      "FileName": "sample string 1",
      "FilePath": "sample string 2",
      "FileType": "sample string 3",
      "FileSize": 4.0,
      "DocType": 1,
      "FormattedName": "sample string 5",
      "IsPMESupported": true
    }
  ],
  "MemberInformationDetails": {
    "PolicyPeriod": "sample string 1",
    "PolicyNumber": "sample string 2",
    "Product": "sample string 3",
    "FirstName": "sample string 4",
    "LastName": "sample string 5",
    "MiddleName": "sample string 6",
    "Dob": "sample string 7",
    "Address": "sample string 8",
    "PostalCode": "sample string 9",
    "PhoneNumber": "sample string 10",
    "Email": "sample string 11",
    "Fax": "sample string 12",
    "PolicyCurrency": "sample string 13",
    "PrimaryMemberGBGID": "sample string 14",
    "Employer": "sample string 15",
    "Country": "sample string 16",
    "GroupName": "sample string 17",
    "IsDifferentSecondary": true,
    "ClaimantFirstName": "sample string 19",
    "ClaimantLastName": "sample string 20",
    "ClaimantMiddleName": "sample string 21",
    "ClaimantDOB": "sample string 22",
    "ClaimantAddress": "sample string 23",
    "ClaimantPostalCode": "sample string 24",
    "ClaimantCountry": "sample string 25",
    "ClaimantPhoneNumber": "sample string 26",
    "ClaimantOccupation": "sample string 27",
    "Sex": "sample string 28",
    "Relastionship": "sample string 29",
    "IndividualNumber": "sample string 30",
    "MembershipNumber": "sample string 31"
  },
  "PaymentModeInformation": {
    "PaymentOptions": "sample string 1",
    "MakePaymentTo": "sample string 2",
    "BankingMethod": "sample string 3",
    "CheckMailingAddress": "sample string 4",
    "Currency": "sample string 5",
    "AccountNumber": "sample string 6",
    "BankName": "sample string 7",
    "BankingAccountType": "sample string 8",
    "BankAddress": "sample string 9",
    "Country": "sample string 10",
    "State": "sample string 11",
    "City": "sample string 12",
    "PostalCode": "sample string 13",
    "BeneficiaryAccountNumber": "sample string 14",
    "BeneficiaryRoutingNumber": "sample string 15",
    "BeneficiaryName": "sample string 16",
    "BeneficiaryAddress": "sample string 17",
    "BeneficiaryCountry": "sample string 18",
    "BeneficiaryState": "sample string 19",
    "BeneficiaryCity": "sample string 20",
    "BeneficiaryPostalCode": "sample string 21",
    "IBANNumber": "sample string 22",
    "SwiftCode": "sample string 23",
    "IntermediaryBank": "sample string 24",
    "IntermediaryBankName": "sample string 25",
    "IntermediaryBankAddress": "sample string 26",
    "IntermediaryBeneficiaryName": "sample string 27",
    "IntermediaryIBANNumber": "sample string 28",
    "IntermediaryRoutingNumber": "sample string 29",
    "ReimbursmentMethod": "sample string 30"
  },
  "Declaration": {
    "InsuredPersonName": "sample string 1",
    "InsuredDate": "2026-04-15T12:01:28.1261381-07:00",
    "PolicyHolderName": "sample string 3",
    "PolicyDate": "2026-04-15T12:01:28.1261381-07:00",
    "IsMember": true
  },
  "Language": 1,
  "ClaimDocumentPath": "sample string 3"
}

<SubmitClaimInputModel xmlns:i="http://www.w3.org/2001/XMLSchema-instance" xmlns="http://schemas.datacontract.org/2004/07/GBG.AS.AgentPortal.API.Areas.SubmitClaim.Models">
  <AdditionalNotes>
    <AdditionalNote>sample string 1</AdditionalNote>
  </AdditionalNotes>
  <Attachments>
    <Attachments>
      <DocType>Claim</DocType>
      <FileName>sample string 1</FileName>
      <FilePath>sample string 2</FilePath>
      <FileSize>4</FileSize>
      <FileType>sample string 3</FileType>
      <FormattedName>sample string 5</FormattedName>
      <IsPMESupported>true</IsPMESupported>
    </Attachments>
    <Attachments>
      <DocType>Claim</DocType>
      <FileName>sample string 1</FileName>
      <FilePath>sample string 2</FilePath>
      <FileSize>4</FileSize>
      <FileType>sample string 3</FileType>
      <FormattedName>sample string 5</FormattedName>
      <IsPMESupported>true</IsPMESupported>
    </Attachments>
  </Attachments>
  <ClaimDocumentPath>sample string 3</ClaimDocumentPath>
  <ClaimReferenceNumber>sample string 1</ClaimReferenceNumber>
  <ClaimType>Health</ClaimType>
  <Declaration>
    <InsuredDate>2026-04-15T12:01:28.1261381-07:00</InsuredDate>
    <InsuredPersonName>sample string 1</InsuredPersonName>
    <IsMember>true</IsMember>
    <PolicyDate>2026-04-15T12:01:28.1261381-07:00</PolicyDate>
    <PolicyHolderName>sample string 3</PolicyHolderName>
  </Declaration>
  <HealthClaimDetails>
    <AuthenticationId>sample string 23</AuthenticationId>
    <ClaimName>sample string 31</ClaimName>
    <Email>sample string 28</Email>
    <Individual>sample string 25</Individual>
    <IsUpdateEmailAndPhone>true</IsUpdateEmailAndPhone>
    <Language>sample string 26</Language>
    <Oid>sample string 27</Oid>
    <PhoneNumber>sample string 29</PhoneNumber>
    <Portal>sample string 24</Portal>
    <RequestId>sample string 22</RequestId>
    <AccidentDetails>sample string 10</AccidentDetails>
    <AutomobileDetails>sample string 11</AutomobileDetails>
    <CoveredByAutomobileInsurance>true</CoveredByAutomobileInsurance>
    <CoveredByMedicareOrGovtAgency>true</CoveredByMedicareOrGovtAgency>
    <CoveredByOtherGroupPlan>true</CoveredByOtherGroupPlan>
    <DeliveryDate>sample string 2</DeliveryDate>
    <DiagnosisDetails>sample string 5</DiagnosisDetails>
    <IllnessOccurredDate>sample string 3</IllnessOccurredDate>
    <InjuryAnyTypeOfAccident>true</InjuryAnyTypeOfAccident>
    <InjuryAnyWayToAutomobileAccident>true</InjuryAnyWayToAutomobileAccident>
    <InjuryAnyWayToPatientsOccupation>true</InjuryAnyWayToPatientsOccupation>
    <IsMaternityTreatment>true</IsMaternityTreatment>
    <OtherSourceDetails>sample string 15</OtherSourceDetails>
    <PreviousDiagnosisDetails>sample string 6</PreviousDiagnosisDetails>
    <ProblemDetails>sample string 4</ProblemDetails>
    <ProviderAddress>sample string 18</ProviderAddress>
    <ProviderCountry>sample string 21</ProviderCountry>
    <ProviderEmail>sample string 19</ProviderEmail>
    <ProviderName>sample string 16</ProviderName>
    <ProviderPhoneNumber>sample string 17</ProviderPhoneNumber>
    <ProviderPostalCode>sample string 20</ProviderPostalCode>
  </HealthClaimDetails>
  <IsSubmit>true</IsSubmit>
  <Language>English</Language>
  <MemberInformationDetails>
    <Address>sample string 8</Address>
    <ClaimantAddress>sample string 23</ClaimantAddress>
    <ClaimantCountry>sample string 25</ClaimantCountry>
    <ClaimantDOB>sample string 22</ClaimantDOB>
    <ClaimantFirstName>sample string 19</ClaimantFirstName>
    <ClaimantLastName>sample string 20</ClaimantLastName>
    <ClaimantMiddleName>sample string 21</ClaimantMiddleName>
    <ClaimantOccupation>sample string 27</ClaimantOccupation>
    <ClaimantPhoneNumber>sample string 26</ClaimantPhoneNumber>
    <ClaimantPostalCode>sample string 24</ClaimantPostalCode>
    <Country>sample string 16</Country>
    <Dob>sample string 7</Dob>
    <Email>sample string 11</Email>
    <Employer>sample string 15</Employer>
    <Fax>sample string 12</Fax>
    <FirstName>sample string 4</FirstName>
    <GroupName>sample string 17</GroupName>
    <IndividualNumber>sample string 30</IndividualNumber>
    <IsDifferentSecondary>true</IsDifferentSecondary>
    <LastName>sample string 5</LastName>
    <MembershipNumber>sample string 31</MembershipNumber>
    <MiddleName>sample string 6</MiddleName>
    <PhoneNumber>sample string 10</PhoneNumber>
    <PolicyCurrency>sample string 13</PolicyCurrency>
    <PolicyNumber>sample string 2</PolicyNumber>
    <PolicyPeriod>sample string 1</PolicyPeriod>
    <PostalCode>sample string 9</PostalCode>
    <PrimaryMemberGBGID>sample string 14</PrimaryMemberGBGID>
    <Product>sample string 3</Product>
    <Relastionship>sample string 29</Relastionship>
    <Sex>sample string 28</Sex>
  </MemberInformationDetails>
  <PaymentDetails>
    <BankAddress>sample string 7</BankAddress>
    <BankId>sample string 20</BankId>
    <BankName>sample string 6</BankName>
    <BankType>None</BankType>
    <BeneficiaryAccountNumber>sample string 8</BeneficiaryAccountNumber>
    <BeneficiaryAddress>sample string 14</BeneficiaryAddress>
    <BeneficiaryName>sample string 9</BeneficiaryName>
    <CheckMailingAddress>sample string 1</CheckMailingAddress>
    <City>sample string 16</City>
    <Country>sample string 17</Country>
    <Currency>sample string 15</Currency>
    <FurtherCreditAccountNumber>sample string 26</FurtherCreditAccountNumber>
    <FurtherCreditBeneficiaryName>sample string 25</FurtherCreditBeneficiaryName>
    <IBANNumber>sample string 12</IBANNumber>
    <IntermediaryBank>sample string 13</IntermediaryBank>
    <IntermediaryBankName>sample string 21</IntermediaryBankName>
    <IntermediaryBeneficiaryName>sample string 22</IntermediaryBeneficiaryName>
    <IntermediaryIBANNumber>sample string 23</IntermediaryIBANNumber>
    <IntermediaryRoutingNumber>sample string 24</IntermediaryRoutingNumber>
    <IsApplyNextInvoice>true</IsApplyNextInvoice>
    <MailingAddressType>None</MailingAddressType>
    <MailingCity>sample string 2</MailingCity>
    <MailingCountry>sample string 3</MailingCountry>
    <MailingPostalCode>sample string 4</MailingPostalCode>
    <MailingState>sample string 5</MailingState>
    <MakePaymentTo>MEMBER</MakePaymentTo>
    <PostalCode>sample string 18</PostalCode>
    <ReimbursmentMethod>Check</ReimbursmentMethod>
    <Routing>sample string 10</Routing>
    <State>sample string 19</State>
    <SwiftCode>sample string 11</SwiftCode>
  </PaymentDetails>
  <PaymentModeInformation>
    <AccountNumber>sample string 6</AccountNumber>
    <BankAddress>sample string 9</BankAddress>
    <BankName>sample string 7</BankName>
    <BankingAccountType>sample string 8</BankingAccountType>
    <BankingMethod>sample string 3</BankingMethod>
    <BeneficiaryAccountNumber>sample string 14</BeneficiaryAccountNumber>
    <BeneficiaryAddress>sample string 17</BeneficiaryAddress>
    <BeneficiaryCity>sample string 20</BeneficiaryCity>
    <BeneficiaryCountry>sample string 18</BeneficiaryCountry>
    <BeneficiaryName>sample string 16</BeneficiaryName>
    <BeneficiaryPostalCode>sample string 21</BeneficiaryPostalCode>
    <BeneficiaryRoutingNumber>sample string 15</BeneficiaryRoutingNumber>
    <BeneficiaryState>sample string 19</BeneficiaryState>
    <CheckMailingAddress>sample string 4</CheckMailingAddress>
    <City>sample string 12</City>
    <Country>sample string 10</Country>
    <Currency>sample string 5</Currency>
    <IBANNumber>sample string 22</IBANNumber>
    <IntermediaryBank>sample string 24</IntermediaryBank>
    <IntermediaryBankAddress>sample string 26</IntermediaryBankAddress>
    <IntermediaryBankName>sample string 25</IntermediaryBankName>
    <IntermediaryBeneficiaryName>sample string 27</IntermediaryBeneficiaryName>
    <IntermediaryIBANNumber>sample string 28</IntermediaryIBANNumber>
    <IntermediaryRoutingNumber>sample string 29</IntermediaryRoutingNumber>
    <MakePaymentTo>sample string 2</MakePaymentTo>
    <PaymentOptions>sample string 1</PaymentOptions>
    <PostalCode>sample string 13</PostalCode>
    <ReimbursmentMethod>sample string 30</ReimbursmentMethod>
    <State>sample string 11</State>
    <SwiftCode>sample string 23</SwiftCode>
  </PaymentModeInformation>
  <TravelClaimDetails>
    <AuthenticationId>sample string 73</AuthenticationId>
    <ClaimName>sample string 81</ClaimName>
    <Email>sample string 78</Email>
    <Individual>sample string 75</Individual>
    <IsUpdateEmailAndPhone>true</IsUpdateEmailAndPhone>
    <Language>sample string 76</Language>
    <Oid>sample string 77</Oid>
    <PhoneNumber>sample string 79</PhoneNumber>
    <Portal>sample string 74</Portal>
    <RequestId>sample string 72</RequestId>
    <ActualDateOfDeparture>sample string 42</ActualDateOfDeparture>
    <ActualFlightOrFerryOrTransportNumber>sample string 44</ActualFlightOrFerryOrTransportNumber>
    <ActualTimeOfDeparture>sample string 43</ActualTimeOfDeparture>
    <AdditionalExpensesDetails>sample string 36</AdditionalExpensesDetails>
    <AmountClaimed>1</AmountClaimed>
    <BaggageMoneyDocuments>true</BaggageMoneyDocuments>
    <CancellationOrCurtailment>true</CancellationOrCurtailment>
    <ClaimMedicalExpensesAndHospitalBenefits>true</ClaimMedicalExpensesAndHospitalBenefits>
    <CorrespondenceAddress>sample string 63</CorrespondenceAddress>
    <DateOfIllnessOrInjury>sample string 8</DateOfIllnessOrInjury>
    <DateOfLossOrDamage>sample string 51</DateOfLossOrDamage>
    <DescriptionOfHowInjuryOccurred>sample string 11</DescriptionOfHowInjuryOccurred>
    <DetailedDescriptionOfLossOrDamage>sample string 53</DetailedDescriptionOfLossOrDamage>
    <DetailsOfExpensesIncurredToReplacePassport>sample string 66</DetailsOfExpensesIncurredToReplacePassport>
    <DetailsOfLossOrDeathOccurred>sample string 69</DetailsOfLossOrDeathOccurred>
    <DetailsOfPersonalPhysicianOrDoctor>sample string 16</DetailsOfPersonalPhysicianOrDoctor>
    <DoesInsuredPersonHavePrivateHealthInsurance>true</DoesInsuredPersonHavePrivateHealthInsurance>
    <EACContactedReason>sample string 23</EACContactedReason>
    <FlightOrFerryOrTransportName>sample string 45</FlightOrFerryOrTransportName>
    <HowManyWeek>1</HowManyWeek>
    <InPatientTreatmentDate>sample string 21</InPatientTreatmentDate>
    <InsuranceCarrierDetails>sample string 25</InsuranceCarrierDetails>
    <InsuredPolicyNumber>sample string 62</InsuredPolicyNumber>
    <IsClaimResultOfAccident>true</IsClaimResultOfAccident>
    <IsInsuredPersonSufferedFromthisBefore>true</IsInsuredPersonSufferedFromthisBefore>
    <IssuerNotifiedIfLossRelatedToTravellers>sample string 54</IssuerNotifiedIfLossRelatedToTravellers>
    <Item1AmountClaimed>1</Item1AmountClaimed>
    <Item1CostNow>1</Item1CostNow>
    <Item1Description>sample string 56</Item1Description>
    <Item1PricePaid>1</Item1PricePaid>
    <Item1PurchasedPalceAndDate>sample string 57</Item1PurchasedPalceAndDate>
    <Item2AmountClaimed>1</Item2AmountClaimed>
    <Item2CostNow>1</Item2CostNow>
    <Item2Description>sample string 58</Item2Description>
    <Item2PricePaid>1</Item2PricePaid>
    <Item2PurchasedPalceAndDate>sample string 59</Item2PurchasedPalceAndDate>
    <JourneyBooked>sample string 29</JourneyBooked>
    <JourneyCancelledExplanation>sample string 31</JourneyCancelledExplanation>
    <JourneyCancelledOrCurtailed>sample string 30</JourneyCancelledOrCurtailed>
    <JourneyEndDate>sample string 2</JourneyEndDate>
    <JourneyStartDate>sample string 1</JourneyStartDate>
    <MedicalExpensesAddress>sample string 17</MedicalExpensesAddress>
    <MedicalExpensesEmail>sample string 20</MedicalExpensesEmail>
    <MedicalExpensesFax>sample string 19</MedicalExpensesFax>
    <MedicalExpensesPhoneNumber>sample string 18</MedicalExpensesPhoneNumber>
    <NameAndAddressOfDoctorOrHospital>sample string 12</NameAndAddressOfDoctorOrHospital>
    <NameofInsurer>sample string 60</NameofInsurer>
    <NaturalCausesDetails>sample string 71</NaturalCausesDetails>
    <NatureOfIllnessOrInjury>sample string 7</NatureOfIllnessOrInjury>
    <NumberOfHoursDelayed>1</NumberOfHoursDelayed>
    <PassportLoss>true</PassportLoss>
    <PassportLostPlace>sample string 65</PassportLostPlace>
    <PersonCausedInTripCancelledAndRelationship>sample string 32</PersonCausedInTripCancelledAndRelationship>
    <PersonalAccident>true</PersonalAccident>
    <PlaceOfIllnessOrInjury>sample string 10</PlaceOfIllnessOrInjury>
    <PointOfDeparture>sample string 46</PointOfDeparture>
    <PointOfDestination>sample string 5</PointOfDestination>
    <PointOfMissedConnection>sample string 47</PointOfMissedConnection>
    <PointOfOrigin>sample string 4</PointOfOrigin>
    <ProvideOtherInsuranceDetails>sample string 61</ProvideOtherInsuranceDetails>
    <ReasonForDelayedOrMissedDeparture>sample string 38</ReasonForDelayedOrMissedDeparture>
    <RecommencedTrip>sample string 49</RecommencedTrip>
    <ReimbursementPayable>sample string 34</ReimbursementPayable>
    <ReportedToAuthority>sample string 55</ReportedToAuthority>
    <ScheduledDateOfDeparture>sample string 39</ScheduledDateOfDeparture>
    <ScheduledFlightOrFerryOrTransportNumber>sample string 41</ScheduledFlightOrFerryOrTransportNumber>
    <ScheduledTimeOfDeparture>sample string 40</ScheduledTimeOfDeparture>
    <SufferedIllnessDetails>sample string 15</SufferedIllnessDetails>
    <Time>sample string 52</Time>
    <TimeOfIllnessOrInjury>sample string 9</TimeOfIllnessOrInjury>
    <TransportUsedForDeparturePoint>sample string 48</TransportUsedForDeparturePoint>
    <TravelDelayMissedDeparture>true</TravelDelayMissedDeparture>
    <WasAnEHC>true</WasAnEHC>
    <WasEACContacted>true</WasEACContacted>
    <WasEACContactedIfJourneyWasCurtailed>true</WasEACContactedIfJourneyWasCurtailed>
    <WasInjuryOrDeathResultOfNatural>true</WasInjuryOrDeathResultOfNatural>
    <WasInsuredPersonPregnant>true</WasInsuredPersonPregnant>
    <WasJourney>Holiday</WasJourney>
    <WasPresentedToHospitalOrDoctor>true</WasPresentedToHospitalOrDoctor>
    <WereAdditionalExpensesIncurred>true</WereAdditionalExpensesIncurred>
    <WhenInjuryOrDeathOccur>sample string 68</WhenInjuryOrDeathOccur>
  </TravelClaimDetails>
  <TreatmentDetails>
    <TotalPaidAmount>1</TotalPaidAmount>
    <TotalUnpaidAmount>2</TotalUnpaidAmount>
    <TreatmentItems>
      <TreatmentItems>
        <Cost>1</Cost>
        <CoverageType>Health</CoverageType>
        <Currency>sample string 8</Currency>
        <DateOfPurchase>sample string 4</DateOfPurchase>
        <DateOfService>sample string 2</DateOfService>
        <Description>sample string 3</Description>
        <DrugName>sample string 5</DrugName>
        <NoOfDrugsInTakePerDay>7</NoOfDrugsInTakePerDay>
        <NoOfDrugsPurchased>6</NoOfDrugsPurchased>
      </TreatmentItems>
      <TreatmentItems>
        <Cost>1</Cost>
        <CoverageType>Health</CoverageType>
        <Currency>sample string 8</Currency>
        <DateOfPurchase>sample string 4</DateOfPurchase>
        <DateOfService>sample string 2</DateOfService>
        <Description>sample string 3</Description>
        <DrugName>sample string 5</DrugName>
        <NoOfDrugsInTakePerDay>7</NoOfDrugsInTakePerDay>
        <NoOfDrugsPurchased>6</NoOfDrugsPurchased>
      </TreatmentItems>
    </TreatmentItems>
  </TreatmentDetails>
</SubmitClaimInputModel>

Sample not available.